Dear Dr. Cannell:Thanks for all your work on Vitamin D, I have been supplementing with vitamin D and also found a doctor who will test get my blood levels regularly. I am wondering, does the vitamin A drug, Isotretinoin, compete similarly to vitamin A with vitamin D receptors?
Isotretinoin is often prescribed for inflammatory skin conditions; it is supposed to shrink the sebaceous glands and act as an anti-inflammatory, therefore helping acne and rosacea. Do you think it can have similar negative effects as retinol on Vitamin D usefulness? I am quite concerned after reading your February Newsletter: "Vitamin D, Vitamin A, and Cancer"
Many people might be taking or have taken Isotretinoin for acne and I would greatly appreciate your insights on the effects of Accutane (even low doses like 2.5mg/day) on Vitamin D.
Eric, Scotland
Dear Eric:Isotretinoin or 13-cis-Retinoic Acid (Accutane in the USA) is a retinoid used in severe acne and rosacea as well as in cancer chemotherapy. It may have the same effects on the vitamin D receptor as other retinols. It certainly interferes with vitamin D metabolism.
Rødland O, et al. Serum levels of vitamin D metabolites in isotretinoin-treated acne patients. Acta Derm Venereol.
1992;72(3):217-9.For those taking Isotretinoin for cancer, continue doing what your oncologist says to do, but also get your 25(OH)D to at least 100 ng/ml. If you are taking Isotretinoin for acne, my advice is to stop the Isotretinoin and take adequate doses of vitamin D.
In 1938, Dr. Merlin Maynard showed vitamin D helped acne more than one of the most effective treatments of all time, x-ray treatment. You can download his entire paper for free.
Maynard MT. Vitamin D in acne, a comparison with x-ray treatment. California and Western Medicine:
49 (2);127-132Dr. Maynard wrote beautifully: There is probably no skin disease of greater importance to the human race than acne. It is undoubtedly our commonest skin disease, and it is rare that any individual reaches maturity without having had it in one of its phases. It is a disease of considerable economic importance, as the disfiguring scars of a severe case are never completely obliterated. It is also a disease of youth. It attains its most noxious form at the time the individual first has to earn his own living. It is undoubtedly responsible for many failures in getting business positions. It is also the basis for inferiority complexes and discouragement in young people.
Dr. Maynard published a long case series. In his earlier days, he used x-ray treatment for acne, but when he started using viosterol (vitamin D2) he stopped using x-ray treatment. In reviewing his cases, he found x-ray treatment led to favorable results 48% of the time but vitamin D did so 76% of the time; he used between 5,000 and 14,000 IU per day. Vitamin D3 may work even better than D2, if acne patients take adequate doses, like 10,000 IU/day with frequent 25(OH)D levels.
In summary, he said:
I believe I may say that at no time in my dermatological experience have I felt such complete satisfaction with a treatment as I have with the cases of this series. I know that vitamin D is an imperfect weapon to slay this disfiguring disease, but it undoubtedly gives one a feeling of being well defended. From the patients' viewpoint, it has left little to be desired, as they find themselves improving, both in appearance and in general well-being. Many have expressed the sentiment, ‘Never felt better.’
In 2008, the mechanism of action of vitamin D in the skin was the subject of a lengthy review:
Schauber J, Gallo RL. The vitamin D pathway: a new target for control of the skin's immune response? Exp Dermatol.
2008 Aug;17{8}:633-9.Theoretically, rosacea should not respond to vitamin D, just the opposite, but readers have told me it does. However, if you have been on Isotretinoin, it may take months or years for the excessive vitamin A to get out of your system. The excess vitamin A may continue to compete for the vitamin D’s receptors attention and, until the vitamin A is gone, one may not see the full effects of vitamin D. By the way, just ask any acne patient if their acne gets better after a week of sunning at the beach.
John Cannell
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